It is widely known that hip strenthening plays a significant role in the rehabilitation of knee pain. When it comes to our sagittal-plane loving runners the hips become even more of an issue. However, in 2011 Wiley and Davis published an article in JOSPT that found hip strengthening alone was not enough to alter running mechanics. This gave movement hipsters and research snobs more fuel to trash talk exercises that aren't "functional" or that "research shows" it doesn't elicit some desired EMG number. While I find remedial exercises to be an important step in rehab, I do agree that there needs to be a better transition between rehab and sport specific training.
Assessment
One of the most common hip faults that we see is the contralateral hip drop (trendenlenberg). Many runners have weak hip abductors from overtraining in the sagittal plane and having movement atrophy in the frontal plane. One way I evaluate this is with the single leg stance frontal plane displacement test. To assess for this frontal plane movement dysfunction I look to see how much they shift their weight (COM) over the stance leg. If there is dysfunction, you will see excessive lateral weight shift towards/over the stance leg.
Intervention
Reactive Neuromusclar Training (RNT) is a great way to treat movement pattern compensations. This is done with tactile cues and forces that exagerate the compensation. It alters the afferent stimulation to the CNS and leads to associated changes with the feedforward and feedback motor control systems. The result is that the body's reflex stabilization response is amplified, thus reducing the compensation.Running has been said to be the act of jumping from single leg to single leg. Your body needs to be able to reactively fire your hip abductors to prevent contralateral hip drop upon immediate impact of single leg stance. By going from a double leg stance to a single leg stance with an lateral trunk force you will be training your hip abdcutors to reactively fire and stabilize. It is important to consider that the immediate stabilization and reactive muscle firing is more important than the force attenuation. Below is an exercise I use to help develop dynamic stabilization. It is used for motor control, not for strengthening.http://www.youtube.com/watch?v=KMe8YpYvoW8&feature=plcp
References
Willy RW, Davis IS. The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat. JOSPT. 2011;41(9):625-632, Epub 12 July 2011. doi:10.2519/jospt.2011.3470Bouisset S, Zattara M. Biomechanical study of the programming of anticipatory postural adjustments associated with voluntary movement. J Biomech. 1987; 20:735-742.Cook, Gray. Movement: Functional Movement Systems : Screening, Assessment, and Corrective Strategies. Aptos, CA: On Target Publications, 2010. www.graycookmovement.comAlexander, A. "The Organization of Anticipatory Postural Adjustments." Journal of Automatic Control 12.1 (2002): 31-37Bittencourt N, Juliana M, Ocarino J, et al. Foot and hip contributions to high frontal plane knee projection angle in athletes: a classification and regression tree approach. JOSPT. 2012 --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.
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